Valuing the expertise of enrolled nurses: as nursing shortages continue to worsen both in New Zealand and worldwide, it is hard to understand why some employers are phasing out or restricting the practice of enrolled nurses.

The shortage of hearth professionals, including nurses, is an issue of international concern.

The reasons behind this shortage are many. The career choices young people now have are extensive, resulting in fewer people choosing to enter the health professions. We have an aging population and workforce, which will create further shortages of health professionals at a time when many of the current workforce are facing retirement.

The purpose of the 2003 Health Practitioners Competence Assurance (HPCA) Act is defined as: "The principal purpose of this Act is to protect the health and safety of members of the public by providing for mechanisms to ensure that health professionals are competent and fit to practise their professions." (1)

Last November, I attended a conference in Melbourne catled Skill Mix and Workforce Development: Right Person, Right Job, Right Time, Right Place. A number of presentations focused on health professional shortages. Part of the solution put forward was the need to create what was described as an "education escalator" for health professionals to meet future health care needs. The concept involves making it easy and affordable for people to start in a health profession and then, if they wish, to continue onto a more advanced level by adding to the education they already have, rather than starting at the beginning again. This is something NZNO has been advocating for some time. However we do not seem to be making any progress; in fact we appear to be going backwards.

As nursing becomes more complex, the nursing hierarchy in New Zealand has chosen to make it very difficult for second-level nurses, who are regulated professionals, to work. Instead of employing enrolled nurses--ENs) with 15 or more years' experience--ENs who are accountable, not only to themselves and their employer, but also to Nursing Council and therefore the public--employers are choosing to replace them with caregivers with no experience and as tittle as six weeks' education. In saying this, I do not wish to decry the wonderful job caregivers do, nor minimise the knowledge and skills many have. Nurses are very grateful for the assistance health care assistants (HCAs) provide but it defies logic that someone with extensive experience in a particular flew is being replaced with someone with none.

Some district health boards have policies that state that an EN cannot be employed as an HCA. This has implications for both groups. People working outside health are mystified as to why an employer would implement such a policy and not value someone with experience.

While in Australia last year, I met some nurse executives from Melbourne's metropolitan health service Southern Health. They were shocked to hear New Zealand is phasing out ENs from its workforce, particularly in the public sector, and that more restrictions are being placed on their practice. They found it inexplicable that ENs were being replaced by caregivers who have only had six weeks' education. They were even more astonished to learn that iran Australian EN applied for registration in New Zealand, s/he would be placed on the nurse assistant register and would probably not be employed in a public hospital ENs are a much valued part of the

Australian nursing workforce.

Increasing ENs' scope in Victoria In Victoria, where mandated staffing levels have been implemented, there is significantly less staff turnover now than before this system was introduced. There are 20,000 ENs registered with the Nurses' Board of Victoria. Rather than reducing their scope of practice, the board is increasing their education and scope. It is also working with an education provider to work through a programme that will assist people to move incrementally from caregiver level to registered nurse (RN) level.

In the EN programmes run in New Zealand since 2000 (called registered nurse assistant programmes since 2004) are many women who wanted to train as RNs, but because of the expense and lack of income for three years they were unable to undertake the RN programme. They enrolled in the new EN programmes in good faith, as they saw them as a way of getting into nursing. When they realised they would come out with a nurse assistant qualification instead, many chose to go back to their previous jobs (ie non-nursing work). Some are working as psychiatric assistants. These jobs are not regulated and the nurses could have got them without training as ENs.

New Zealand seems to be embracing the ideology that only RNs should have the title "nurse" but nurses in clinical practice, who are short staffed and often have tittle support, want to work with experienced ENs. A recent article entitled "Nurse staffing in hospitals: Is there a business case for hospitals?" again shows that an educated workforce delivers better outcomes for patients. (2)

We need to be realistic and pragmatic about how to provide the best outcomes for patients and how best to protect the public. If we refer back to the purpose of the HPCA Act and value the contribution aff nurses make to health care teams, we can't go far wrong.

References

(1) HeaLth Practitioners Assurance Act (2003) Public Act 48, p7. New Zealand Government.

(2) Needleman, 3., Buerhaus, P.I., Stewart, M., Zelebinsky, K. & Mattke, S. (2006) Nurse staffing in hospitals: Is there a business case for hospitals? Health Affairs: 25: 1, 204-11.

NZNO professional nursing adviser Margaret Cain